Ariel Santana, 42...was revealed to be the true

owner of A & J Rehabilitation

Center,...that illegally submitted more than $350,000 in fraudulent

claims to various insurance companies.

Volume 5 - Issue 12 June 2015

The Division of Insurance Fraud (DIF) announced two insurance fraud arrests. Ariel Rivero Santana, Jr. and Raul Antonio Perez Payes, both of Miami, were arrested for their roles in separate personal injury protection or PIP fraud scams.

Ariel Santana, 42, was taken into custody after he was revealed to be the true owner of A & J Rehabilitation Center, a PIP clinic located in Miami that illegally submitted more than $350,000 in fraudulent claims to various insurance companies.

In an effort to circumvent licensure requirements, Santana hired chiropractor Peter Maffetone to operate as the clinic’s straw owner. As a licensed health care professional, Maffetone fraudulently obtained a licensure exemption from the Agency for Health Care Administration, allowing the clinic to operate without a license for more than three years. Santana and Maffetone went on to submit fraudulent claims totaling nearly $367,000 to four insurance carriers: Esurance, Geico, Progressive and United Auto.

Six additional participants and organizers tied to Santana have been arrested by DIF detectives within the last year. All of them are connected to two staged accidents that accounted for fraudulent billings of more than $180,000 to multiple clinics, including A & J Rehabilitation Center.

In a separate case, DIF detectives arrested Raul Antonio Perez Payes, 31, after detectives learned that he organized a staged car accident in August 2012. In addition to planning the staged accident, Payes recruited and paid accomplices to participate in the scam.

Investigators determined that Payes offered one individual at least $500 to be a passenger, and, after reporting the staged crash to the Florida Highway Patrol to create a crash report, Payes paid another participant $2,500 to visit various PIP clinics for the treatment of fake injuries. The resulting fraudulent insurance claims totaled more than $86,000. Since late 2014, four additional participants tied to this staged accident have been arrested.

With more than 20 felony counts filed against him, Raul Payes faces to up to 120 years if convicted. Arial Santana faces up to 25 years in prison if convicted. Both cases will be prosecuted by the office of Miami-Dade County State Attorney Katherine Fernandez Rundle, and both were booked into Turner Guilford Knight Correctional Center in Miami.

Anyone with information about suspected insurance fraud is asked to call 1-800-378-0445. Citizens who provide tips can remain anonymous. The Department of Financial Services has awarded $350,000 to 60 citizens as part of its Anti-Fraud Reward Program. The program rewards individuals up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

INSIDE THIS ISSUE

1 Miami Arrests

3 Most Wanted

4 PIP Fraud News

5 Patient Brokering

6 Statewide Arrests

7 Statewide Contacts

HEADER HERE DIF Arrests Clinic Owner, Staged Accident Organizer in Miami

Page 2 June 2015

In May, detectives from the Hialeah Police Department arrested three subjects following an investigation into illegal activity at A Miranda Medical Center, a PIP clinic in Hialeah.

Arrested were clinic owner Gabriel Miranda, 35, office manager Noemi Vazquez, 44, and Ailyn Columbie, 30, who was the paper owner.

Charges filed include insurance fraud, staged accident, organized scheme to defraud and patient brokering.

A Miranda Medical Center has operated since 2006.

See this story by NBC6 at http://www.nbcmiami.com/news/local/3-Facing-Charges-in-Staged-Accidents-Scheme-Hialeah-Police-307067531.html.

DIF Arrests 8 In Broward County Staged Accident

Chief Financial Officer Jeff Atwater announced the arrests of eight Broward County residents for PIP (personal injury protection) fraud. An investigation by the Division of Insurance Fraud revealed the arrested individuals staged a motor vehicle accident in Fort Lauderdale using a hotel van filled with passengers who participated in the scam.

Ronie Petidos of Corals Springs, Patrick Logene of Tamarac and Marc La Pierre of Pompano Beach were arrested for organizing the accident and sending the participants to clinics they controlled. The participants were also instructed and agreed to file fraudulent insurance claims and begin unnecessary therapy treatments.

The arrested van passengers include Shaeronda Jackson and Jeffrey Louis of Fort Lauderdale and Jean Regisma of Lauderhill. Stephen Blanc of Lauderdale Lakes and Kennsly Giles of Fort Lauderdale, who were also arrested, were recruited to ride in the at fault vehicle that crashed into the van.

Two additional suspects are still being sought for arrest.

The case is being prosecuted by the office of 17th Judicial Circuit State Attorney Michael J. Satz.

Accident organizers Petidos and La Pierre were previously arrested in 2014 for their role in another staged accident that occurred in 2012 in Hollywood, Florida. This criminal case is still pending in the Broward Judicial Court system.

Hialeah PD Arrests 3 in Operation Trojan Horse

Page 3 The PIP Source

Check out the DFS Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/

DIF Reorganization Update

Carlos Alberto Alvarez-Gutierrez AKA Carlitos Alvarez White Male, 54 years old 5’10”, Brown Eyes, Gray Hair Warrant Information: Warrant/Case #: W987552434 Felony Warrant Charge: Insurance Fraud Details: The Florida Department of Financial Services, Division of Insurance Fraud (DIF) is attempting to locate Carlos Alberto Alvarez-Gutierrez in reference to the outstanding warrant. Alvarez-Gutierrez made false statements about the number of times he received treatment at a medical facility to benefit monetarily from personal injury protection benefits after a car crash. Alvarez-Gutierrez has yet to be found since his warrant was issued in June 2013. His warrant is Florida pick-up only. If you know where Alvarez-Gutierrez can be located, please contact the Division of Insurance Fraud at 1-800-378-0445.

With the promotion of Captain Darrell Wilson, the Division of Insurance Fraud has once again reorganized its regions.

The North Central Region was divided to create the West Central Region, which includes the Tampa and St. Petersburg offices. The North Central Region retains the Orlando offices.

To the right is the latest map showing the breakdown of the regions and the counties they cover.

Page 4 June 2015

Darrell Wilson Promoted To Captain Of DIF West Central Region Darrell Wilson was promoted to Captain of the newly formed West Central Region, which was formerly part of the North Central Region and is made up of the Tampa and St. Petersburg offices.

Wilson joined our division in 2010 after serving two decades in local law enforcement, serving in significant investigative and management roles. He holds a Bachelor of Arts degree in Organizational Management and a Master of Science degree in Management from Warner University.

Congratulations to Captain Wilson!

Clinic Owners Charged By Feds In Million Dollar Fraud Scheme According to a federal indictment, Janio Vico and Jharildan Vico had a plan: own a rehabilitation center, put a doctor up front, stage a few car accidents, and then make at least $1 million in false insurance claims.

The Vicos were arrested Thursday and face 12 counts of mail fraud and one count of conspiracy to commit mail fraud. The two men who operate V & C Rehabilitation Center out of Lake Worth face up to 20 years imprisonment if convicted.

According to investigators, the two men, along with other co-conspirators, submitted fraudulent claims since at least 2009 for unnecessary medical treatments for those who claimed they were injured in staged car accidents.

Read more details in this story by Hannah Winston at the Palm Beach Post - http://www.palmbeachpost.com/news/news/crime-law/two-face-fraud-charges-stemming-from-insurance-cla/nk8GR/.

Trooper Charged In Federal Investigation Of Pirate Tow Trucks Kirk Chambers, 41, and Guillermo “Tony” Sepulveda, 43, were arrested in April as part of an FBI investigation into Miami-Dade tow-truck operators suspected of paying bribes to police officers, police department employees and FHP troopers “to steer illicit business in their direction,” according to a criminal complaint filed by federal prosecutor Anthony Lacosta.

Chambers is accused of scheming with local towing operator Sepulveda to sell hundreds of confidential accident reports for $6,200 in a sting operation run by the FBI. Florida law prohibits the release of crash reports to third parties before a 60-day period. Providing access to such reports within that time frame is unlawful for the purpose of soliciting business, such as towing, auto repairs or medical care.

The FBI made its first arrests in the towing-kickback probe in March, when four tow-truck operators and two Miami police aides were charged with bribery and fraud. No police officers were arrested in the initial take-down. But arrests of city police officers in this alleged scam are expected later this year.

In May, Chambers entered a plea of guilty and is now awaiting sentencing.

See more details in this story by the Miami Herald’s Jay Weaver at http://www.miamiherald.com/news/local/crime/article19966026.html, this NBC6 report at http://www.nbcmiami.com/news/local/Former-Florida-Trooper-Charged-in-Bribery-Scheme-302356001.html and here http://www.insurancejournal.com/news/southeast/2015/05/28/369732.htm.

Dual Insurance Verification Operations Held in Broward, Palm Beach Counties In April, Broward and Palm Beach County Sheriff’s Offices held insurance verification operations. Both were coordinated by the National Insurance Crime Bureau (NICB). The operation resulted in the issuance of more than 440 citations and 15 arrests for various crimes, including one fake insurance card.

Twenty-eight insurance carriers participated in the two-county operation including 21st Century, Allied, Allstate, Assurant, Dairyland, Depositors, Direct General, Farmers, Geico, Hartford, Imperial Fire, Infinity, Mapfre, Mercury, MetLife, Nationwide, National General, Omni, Peak, Redland, Security General, Sentry, State Farm, Titan, Travelers, United Auto, Victoria and Windhaven.

Jacksonville Man Sentenced in Staged Accident Scheme Nelson Cata Gacita, 40, was sentenced to five years in prison following his conviction for a staged accident claim that occurred in July 2011. Gacita was also ordered to pay back $28,224.37 in restitution to the insurance companies victimized in the scheme. Gacita was arrested with three other participants by the Division of Insurance Fraud in March 2014.

See more at this link from News4 in Jacksonville - http://www.news4jax.com/news/jacksonville-man-sentenced-in-fraud-scheme/33272484.

PIP FRAUD – In The News

Page 5 The PIP Source

PIP FRAUD SPOTLIGHT ON - Patient Brokering

In general terms relating to PIP fraud, patient brokering is the payment, offer of payment, or solicitation of payment relating to the treatment of a patient by a clinic. If you are involved in an accident, it is illegal for you to ask anyone to pay you to treat at any clinic; and it is illegal for anyone to offer to pay you or to actually pay you to treat at any clinic. Unfortunately, this illegal activity takes place every day, and the notion is supported by the endless run of confusing commercials on television and radio, advertising to accident victims that they are entitled to benefits under the PIP laws in Florida. While the original no-fault statute was passed with good intentions, most of the commercials run by law firms or attorney referral services do not make clear that in most cases, the money from the PIP benefits will be paid by the insurance company to the clinic or the law firm, and not to the patient. Much of the money that is actually paid to patients is done so illegally, by the clinics or the recruiters who stage accidents, and is a fraction of what the clinics are paid by the insurance company. This crime is further compounded by the activity at many accident clinics where the patients do not receive treatment, but merely sign for it.

There is, unfortunately, a belief and understanding that if you are involved in a car crash, you can make money, even if you are not injured. The Division of Insurance Fraud (DIF) has investigated cases where the patients initiate the offer, often blatantly asking the doctor or clinic employee how much the clinic will pay them to treat. DIF has also received calls from chiropractors who have reported losing patients to other clinics because they refused to pay a patient to treat with them, or in at least one case, did not pay as much as their competition. It is illegal to be paid as a patient.

If you are offered money to treat at a clinic, report the offer to our fraud hotline at 1-800-378-0445 and you could be eligible for a reward of up to $25,000. If you make or accept the offer, you could be eligible for a ride to jail. Don’t make the wrong decision.

Patient brokering - Florida Statutes 817.505:

(1) It is unlawful for any person, including any health care provider or health care facility, to:

(a) Offer or pay any commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of patients or patronage to or from a health care provider or health care facility;

(b) Solicit or receive any commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for referring patients or patronage to or from a health care provider or health care facility;

(c) Solicit or receive any commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, in return for the acceptance or acknowledgement of treatment from a health care provider or health care facility; or

(d) Aid, abet, advise, or otherwise participate in the conduct prohibited under paragraph (a), paragraph (b), or paragraph (c).

…

(4) Any person, including an officer, partner, agent, attorney, or other representative of a firm, joint venture, partnership, business trust, syndicate, corporation, or other business entity, who violates any provision of this section commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

Coming Soon in the Spotlight: We take a in-depth look at Operation Sledgehammer.

Page 6 June 2015

Statewide PIP Arrests – May 2015 Each issue will provide a list of PIP arrests made by the offices throughout the State. Along with each defendant’s name and age, we will include: the type of scheme involved; the fraud dollar amount; clinic name(s); victim insurance company name(s); and the arresting office. If you need additional details on any of these arrests, please contact Capt. Smith.

Kennsly Jean Gilles, 29 - staged acct 06/20/12 (passenger) $77,484 - Commercial Point Physical Center / Hollywood Pain & Rehab Center / New Hope Holistic Care Center (Gainsco / Hartford) B

Danay Torres-Gomez, 33 - clinic employee / staged acct 08/16/12 (passenger) $55,984 - Arlington Rehabilitation Services / First Coast Primary / Gate Parkway Diagnostic Center Care (Farmers / First Acceptance / Geico / United Auto) J

Yarely Cosme Torres, 33 - staged acct 08/16/12 (passenger) $55,984 - Arlington Rehabilitation Services / First Coast Primary / Gate Parkway Diagnostic Center Care (Farmers / First Acceptance / Geico / United Auto) J

Juan Lao Betancourt, 45 - application fraud (Allstate) M

Christopher M Piccareto, 43 - false claim (Geico) T

Daniel Gerardo Fonseca Moran, 50 - staged acct 12/03/11 (recruiter) $47,754 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center / One Touch Therapy Center (State Farm) J

Justin Paul Phillips, 29 - jump-in 04/30/14 - $3,520 - Mason Injury & Accident (Infinity) O

Jean Previlus, 50 - clinic owner - $67,346 - Unity Pain and Injury Center (Geico / Progressive / State Farm / USAA) O

Quanteria Matquisha Reed, 26 - fake ins card (American Service) W

Jose Orlando Mendez, 35 - staged acct 05/13/13 (passenger) $89,040 - D& J Rehabilitation Center / Health and Wellness Services (Direct General / State Farm) M

Shineka L Smith, 22 - jump-in 04/30/13 - $40,996 - Accident Injury Center (First Acceptance) O

Florian Guardado de la Torre, 58 - PIP patient - $1,470 - Health & Wellness Services (Allstate) M

Vorawut Likhitvorawat, 71 - false claim - $7,278 (Farmers) B

Carmen Iris Rodriguez, 39 - staged acct 11/14/11 (passenger) $17,115 - San Jose Injury Center (Farmers) J

Neshwattie Gaya, 56 - application fraud (Geico) W

Chauncey Allen Thomas, 40 - fake ins card (Gainsco) M

Edelso Carmenates Alvero, 42 – staged acct 02/27/12 (driver) $42,640 - Magic Spot Medical Center (Geico / State Farm) M

Josetta Bradley, 39 - application fraud (Geico) T

Richard Edward Harrington, Jr - title fraud / id theft (Geico) T

Michael Alan Bunkley, 46 - false claim - $ (Ace American) TL

Trisha Milstead, 43 - false claim - $12,077 (Direct General) P

Danielle Marie Daniluk, 29 - jump-in 04/30/14 - $8,536 - Mason Injury & Accident (Infinity) O

Donald Mohammed, 49 - fake receipt - $350 (Geico) M

Anthony J Cirruzzo, 56 - patient brokering - West Coast Medical Management (Direct General / Farmers) T

Glenda Kay Raggins, 52 – pedestrian / false claim - $555 (Sentry) J

Carl Lee Lorenzo Raggins, 49 – statement in support of false claim - $555 (Sentry) J

Ariel Rivero Santana, 42 – unlicensed clinic owner - $366,657 - A & J Rehabilitation Center (Esurance / Geico / Progressive / United Auto) M

Christian Giovanni Lozano, 21 - jump-in 11/05/14 - $11,640 (Florida Blue / Geico) B

Raul Antonio Perez Payes, 30 - staged acct 08/04/12 (recruiter) $86,152 - CI Medical Center / Doral Health Center / Fiallo Care Therapy Center / Health Professional Services / YH Imaging (Geico / United Auto / Windhaven) M

Arrested in April 2015

Rose Anna Marie Gustin, 31 - jump-in 04/30/14 - $3,365 - Mason Injury & Accident (Infinity) O

Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)

Copy goes her. Editor’s Corner On page 1, we cover the arrests of a clinic owner and staged accident organizer in Miami.

On page 3, we feature another fugitive in Insurance Fraud’s Most Wanted.

As always, we report on PIP Fraud in the News and the latest PIP-related arrests.

Page 7 The PIP Source

DISTRICT I Major Michael BYRNE

PANHANDLE REGION Counties: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, Washington

Pensacola Field Office - 850.453.7802 Capt. David LINDSAY Lt. Sandra FITZSIMONS Tallahassee Field Office - 850.413.3115 Lt. Ernie STOLL

NORTH REGION Counties: Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Levy, Marion, Nassau, Putnam, St. Johns, Sumter, Suwannee, Union

Jacksonville Field Office - 904.798.5802 Capt. Brian McCOY Lt. Kevin JONES

NORTH CENTRAL REGION Counties: Brevard, Hillsborough, Lake, Orange, Osceola, Seminole, Volusia

Orlando Field Office - 407.835.4402 Capt. Evangelina BROOKS Lt. Laquanda GREEN Lt. John SAVINO

WEST CENTRAL REGION Counties: DeSoto, Hardee, Hernando, Manatee, Pasco, Pinel-las, Polk, Sarasota

Tampa Field Office - 813.972.8602 Capt. Darrell WILSON Lt. Carlos ROSARIO St Petersburg Field Office - 727.563.1142 Lt. Carl LANE

DISTRICT II Major Rafael DELGAGO

SOUTH CENTRAL REGION Counties: Broward, Charlotte, Collier, Glades, Hendry, Highlands, Indian River, Lee, Martin, Okeechobee, Palm Beach, St. Lucie

Plantation Field Office - 954.958.5402 Lt. Bill LEE West Palm Beach Field Office - 561.837.5601 Lt. James FEENEY Ft. Myers Field Office - 239.278.7527 Acting Lt. Glen CLASEN

SOUTH REGION Counties: Dade, Monroe

Miami Field Office - 305.536.0302 Capt. Steven SMITH Lt. Violeta SERRANO Lt. Stanley JEAN-FELIX Lt. Missael DIAZ

South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 847.544.7141 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Jose Olivier 813.558.6387

Statewide PIP Contacts